Provider Demographics
NPI:1295893485
Name:CONNELL, BETH ANN (DC)
Entity type:Individual
Prefix:DR
First Name:BETH ANN
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTH MILL STREET
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:IL
Mailing Address - Zip Code:61373
Mailing Address - Country:US
Mailing Address - Phone:815-667-4819
Mailing Address - Fax:
Practice Address - Street 1:NORTH MILL STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:IL
Practice Address - Zip Code:61373
Practice Address - Country:US
Practice Address - Phone:815-667-4819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2549111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5082021OtherBCBS PROVIDER #
T35698Medicare UPIN
IL259650Medicare ID - Type Unspecified